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What Your Nails Say About Your Health

Hold that polish! Or at least give your nails a good look before you paint them. Your fingernails and toenails are like 20 mini-mirrors to the state of your overall health. Changes throughout the body that are otherwise invisible can sometimes be first seen in the nails, says dermatologist Amy Newburger, a senior attending physician at St. Luke's - Roosevelt Medical Consortium in New York City.

Fingernails tend to give more reliable clues than toenails, given the wear and tear of walking, tight shoes, and slower foot circulation over time, which can obscure toenail changes. But check both hands and feet -- the first of the following nine nail clues explains why.

Clue 1: A black line

Look for: A black discoloration that's a straight vertical line or streak and grows from the nail bed, usually on a single nail. About 75 percent of cases involve the big toe or the thumb, according to a review in the British Journal of Dermatology. Especially worrisome: a discoloration that's increasing or that's wider at the lower part of the nail than the tip. "That tells you that whatever is producing the pigment is producing more of it," says Newburger.

Also beware when the skin below the nail is deeply pigmented as well, says podiatrist Jane Andersen of Chapel Hill, North Carolina, a spokeswoman for the American Podiatric Medical Association.

What it might mean: Melanoma, the deadliest form of cancer. People with darker skin are more vulnerable than Caucasians to subungual melanoma (melanoma of the nail bed), but darker-skinned races also have more dark lines in nails that are benign, according to a 2004 report in American Family Physician.

Next steps: Always have a doctor check out a suspicious black line on the nail quickly because of the high skin cancer risk. A black line on the nail may also be caused by a harmless mole or an injury. A biopsy can confirm melanoma.

Clue 2: Small vertical red lines

Look for: Red (or sometimes brownish red) streaks in the nail. "They look like blood or dried blood," Anderson says. These are known as "splinter hemorrhages" because they look like a splinter but are caused by bleeding (hemorrhage) under the fingernail or toenail. They run in the same direction as nail growth.

What it might mean: Heart trouble. The "splinters" are caused by tiny clots that damage the small capillaries beneath the nail. They're associated with an infection of the heart valves known as endocarditis. Don't panic if you see one, though: Sometimes an ordinary injury to the nail can cause a splinter hemorrhage.

Next steps: No treatment is needed for the splinter hemorrhage itself. A doctor can evaluate and treat the underlying cause if it's heart-related.

Clue 3: Wide, "clubbed" nails

Look for: Uniformly widened fingertips or toes -- they appear to bulge out beyond the last knuckle -- where the nails have widened, too, so that they curve down and appear to wrap around the tips of the finger like an upside-down spoon. (Normal nails are narrower than their base fingers.) These extra-wide nails are called "clubbed" nails.

What it might mean: Clubbed nails are a common sign of pulmonary (lung) disease, Newburger says. Although the nails' odd shape develops over many months to years, people are often unaware of the underlying condition, which can include lung cancer.

Next steps: If you haven't had a physical exam lately, consider one, especially if you have other symptoms such as coughing or shortness of breath.

Clue 4: Spoon-like depressions

Look for: Nail beds that have little dips in them, an effect called koilonychia, or "spooning." "If you put your hand flat on the table, the spooned nails look like they could each hold liquid," Newburger says. The nails will also be unusually pale or stay whitish for more than a minute after you press gently on one. (Normally it would turn white for a second or two before returning to its original pinkish color.) The moons at the base of the nails may look particularly white.

What it might mean: Iron-deficiency anemia. Spooning can also be seen in the nails of people with hemochromatosis, or "iron overload disease," a condition usually caused by a defective gene that leads to too much iron being absorbed from the gastrointestinal tract. Other symptoms for both conditions can include fatigue and lack of energy, or they may be symptomless.

Next steps: A complete blood count can diagnose anemia, and a physical exam might pinpoint the cause of iron problems. Iron supplements and dietary changes are often prescribed as first-line treatments for anemia.

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About the Author

Paula Spencer Scott, contributing editor, is the author of Surviving Alzheimer's. A Met Life Foundation Journalists in Aging fellow, she writes extensively about health and caregiving; four of her family members have had dementia.

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